在开放式Lichtenstein腹股沟疝修补术(IHR)中使用胶水作为网状固定器已越来越受欢迎,以减少复发和术后并发症。这项荟萃分析旨在提供最新的综述,以比较原发性开放LichtensteinIHR中的胶水与缝线固定。
PubMed,Embase,科克伦图书馆,WebofScience,在2021年6月之前,对Springer进行了系统搜索,以比较开放LichtensteinIHR中胶水固定与缝线固定的随机对照试验(RCT)。主要结果是早期(1年)和晚期复发(5年或更长时间)。次要结果是手术时间,术后血肿和血清肿,和慢性疼痛在1年。
共包括17个RCT,其中有3150个疝(胶水n=1582,缝线n=1568)。只有三项研究报告了晚期复发。胶水固定与手术时间较短相关(MD-4.17,95%CI-4.82,-3.52;p<0.001,血肿形成的发生率较低(OR0.51,95%CI0.32,0.81;p=0.004)。术后血清肿无显著差异(OR0.72,95%CI0.35,1.49;p=0.38),1年后慢性疼痛(OR1.10,95%CI0.73,1.65;p=0.65),早期复发(OR1.11,95%CI0.45,2.76;p=0.81,I2=0%),和晚期复发(OR1.23,95%CI0.59,2.59;p=0.59,I2=0%)。
在开放性LichtensteinIHR患者中,胶水和缝线固定的早期和晚期复发具有可比性。与缝线固定相比,胶水固定的手术时间更短,血肿形成更少。慢性疼痛和血清肿形成相当。更多的RCT应该报告长期结果。
The use of glue as a mesh fixator in open
Lichtenstein inguinal hernia repair (IHR) has gained popularity to reduce recurrence and postoperative complications. This meta-analysis aims to provide an up-to-date
review to compare glue versus suture fixation in primary open
Lichtenstein IHR.
PubMed, Embase, The Cochrane Library, Web of Science, and Springer were systematically searched till June 2021 for randomized controlled trials (RCTs) comparing glue versus suture fixation in open
Lichtenstein IHR. Primary outcomes were early (at 1 year) and late recurrence (5 years or more). Secondary outcomes were the length of operation, postoperative haematoma and seroma, and chronic pain at 1 year.
A total of 17 RCTs with 3150 hernias (glue n = 1582, suture n = 1568) were included. Only three studies reported late recurrence. Glue fixation was associated with shorter operative duration (MD - 4.17, 95% CI - 4.82, - 3.52; p < 0.001 and a lower incidence of haematoma formation (OR 0.51, 95% CI 0.32, 0.81; p = 0.004). There was no significant difference in postoperative seroma (OR 0.72, 95% CI 0.35, 1.49; p = 0.38), chronic pain after 1 year (OR 1.10, 95% CI 0.73, 1.65; p = 0.65), early recurrence (OR 1.11, 95% CI 0.45, 2.76; p = 0.81, I2 = 0%), and late recurrence (OR 1.23, 95% CI 0.59, 2.59; p = 0.59, I2 = 0%).
Early and late recurrence were comparable between glue and suture fixation in open
Lichtenstein IHR patients. Glue fixation had shorter operating time and lower haematoma formation than suture fixation. Chronic pain and seroma formation were comparable. More RCTs should report long-term outcomes.